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Treating people who intentionally swallow foreign objects can be costly, a study finds

Most hospitals have their share of weird cases, but Rhode Island Hospital may win some kind of prize for having an abundance of instances of treating people who have intentionally swallowed foreign objects.

If you're at all squeamish, you should probably stop reading.

A study released this week in the journal Clinical Gastroenterology and Hepatology analyzed 305 cases of 33 people intentionally ingesting foreign objects that occurred over about eight years in that hospital.

Almost 80% of the cases involved people who had been diagnosed at some point with a psychiatric disorder. Among those treated as an inpatient or outpatient were people admitted from prison and from private homes in the area. The majority were from residential institutions, most of them from a state-run chronic psychiatric inpatient facility.

The most common items swallowed were pens (whole or in parts), followed by batteries, knives, razor blades, other metal objects, pencils, toothbrushes, spoons and coins. Despite the number of sharp objects ingested there were no deaths or perforations reported in any of the cases. Most of the procedures that involved an endoscope (a scope with a light used to look inside the body) were done under general anesthesia, with most objects removed via snares, forceps and nets. Some objects passed through the body naturally, and in two cases the objects had to be surgically removed. One patient was responsible for 67 cases, and four people contributed to 179 cases.

The study authors estimated the cost for these procedures at about $2 million, most of it paid by Medicare and Medicaid. They also noted that recurring cases of intentional swallowing are "often resistant to treatment," including medication. Some patients were able to swallow items again while being watched by guards.

These cases of swallowing foreign objects, they write, "are poorly understood, difficult to treat, and consume considerable physician time and hospital resources. Patients with these behaviors generate frustration, anger, and negative affect in treating physicians and other hospital staff."